Comparison of the French DRG based information system (PMSI) with the National Mesothelioma Surveillance Program database

BACKGROUND: One of the main purposes of the French National Mesothelioma Surveillance Program is to estimate and follow the national incidence of pleural mesothelioma. We wanted to study the contribution of the French hospital national database as a valid source of mesothelioma incident cases. METHODS: From the 1998 and 1999 hospital national database, medical records with a diagnosis code of mesothelioma or pleural cancer where selected among patients who resided in one of the 17 administrative divisions covered by the National Mesothelioma Surveillance Program in 1998. From these records, 506 patients in 1998 and 474 patients in 1999 where identified and matched with the National Mesothelioma Surveillance Program cases over the same period using indirect criteria of identification (sex, age, place of residence). Medical records of cases unknown by the National Mesothelioma Surveillance Program where consulted in one of the administrative divisions. RESULTS: Only two-thirds of the registered cases of the National Mesothelioma Surveillance Program could be matched with a patient identified in the hospital national database with a diagnosis of mesothelioma registered during the same year. Consultation of the medical records showed that 1) certified cases registered in the National Mesothelioma Surveillance Program where often (83%) found in the hospital national database with a code of mesothelioma but 10 to 15% of the patients with a code of mesothelioma in the national hospital databases had a different diagnosis according to their medical records; 2) 65% of the patients with a code of mesothelioma in the national hospital databases that where unknown from the National Mesothelioma Surveillance Program in 1998 and 55% in 1999 where prevalent cases; 3) 3 suspected cases had not been reported to the National Mesothelioma Surveillance Program. CONCLUSION: Because of lack of diagnosis certification, mistakes in encoding diagnosis and the fact that incident and prevalent cases cannot be distinguished in the hospital national database make it impossible to estimate the mesothelioma incidence solely from this source of data. However, the hospital claim databases constitute a complementary source of information for the active search of incident cases performed by the National Mesothelioma Surveillance Program.     

Use of the French medico-administrative database (PMSI) to detect nosocomial infections in the University hospital of Lyon

BackgroundSurveillance is an effective element in the fight against nosocomial infections, but the monitoring methods are often cumbersome and time consuming. The detection of infection in computerized databases is a means to alleviate the workload of health care teams. The objective of this study was to evaluate the performance of using discharge summaries in medico-administrative databases (PMSI) for the identification of nosocomial infections in surgery, intensive care and obstetrics.MethodsThe retrospective assessment study included patients who were hospitalized in general surgery, intensive care and obstetrics at different periods of time in 2006 and 2007 depending on the wards. Patients were monitored according to standard protocols which are coordinated at the regional level by the Southeast coordinating centre (CCLIN). The performance of identifying cases of nosocomial infection from discharge diagnoses coded by using the International Classification of Diseases (tenth revision) was evaluated by a study of sensitivity, specificity, positive and negative predictive values with their 95% confidence intervals.ResultsUsing a limited number of diagnostic codes, the sensitivity and specificity were, respectively, 26.3% (95% CI 13.2–42.1) and 99.5% (95% 98.8–100.0) for the identification of surgical site infections. By expanding the number of diagnostic codes, the sensitivity and specificity were 78.9% (95% CI 65.8–92.1) and 65.7% (95% CI 61.0–70.3). The sensitivity and specificity for case identification of nosocomial infections in intensive care were 48.8% (95% CI 42.6–55.0) and 78.4% (95% CI 76.1–80.1), and were 42.9% (95% CI 25.0–60.7) and 87.3% (95% CI 85.2–89.3) for identification of postpartum infections.ConclusionThe PMSI is not a sufficiently efficient method in terms of sensitivity to be used in surveillance of nosocomial infections. A reassessment of the PMSI must be considered, with changes in coding of comorbidity that occurred in 2009.     

Critical analysis of French DRG based information system (PMSI) databases for the epidemiology of cancer: a longitudinal approach becomes possible

BackgroundUse of French Diagnosis Related Groups (DRGs) program databases, apart from financial purposes, has recently been improved since a unique anonymous patient identification number has been created for each inpatient in administrative case mix database. Based on the work of the group for cancer epidemiological observation in the Rhône-Alpes area, (ONC-EPI group), we review the remaining difficulties in the use of DRG data for epidemiological purposes and we consider a longitudinal approach based on analysis of database over several years. We also discuss limitations of this approach.DifficultiesThe main problems are related to a lack of quality of administrative data, especially coding of diagnoses. These errors come from missing or inappropriate codes, or not being in accordance with prioritization rules (causing an over- or under-reporting or inconsistencies in coding over time). One difficulty, partly due to the hierarchy of coding and the type of cancer, is the choice of an extraction algorithm. In two studies designed to estimate the incidence of cancer cared in hospitals (breast, colon-rectum, kidney, ovaries), a first algorithm, including a code of cancer as principal diagnosis with a selection of surgical procedures less performed than the second one including a code of cancer as principal diagnosis only, for which the number of hospitalizations per patient ratio was stable across time and space. The chaining over several years allows, by tracing the trajectory of the patient, to detect and correct inaccuracies, errors and missing values, and for incidence studies, to correct incident cases by removing prevalent cases.DiscussionHowever, linkage, complete only since 2007, does not correct data in all cases. Ways of future improvement certainly pass through improved algorithms for case identification and especially by linking DRG data with other databases.     

后关系型数据库在HIS中的应用

本文针对我国医院信息系统(HIS)中系统响应速度慢和系统可靠性差,系统安全性上存在着隐患,难以适应医院365天、每天24小时可靠运行的要求,提出了基于后关系型数据库(Caché)的医院信息系统开发是解决目前我国HIS系统中诸多问题的理想可选方案。最后介绍了后关系型数据库Caché的技术特点以及Caché在HIS系统开发中的技术优势。     

基于JAVA的分布式数据库模型在医疗信息系统中的应用研究

本文在比较传统的分布式数据库模型并分析医疗信息系统发展需求的基础上 ,提出了适合于目前医疗信息系统的多层模型结构 ,并详细论述了其结构组成和功能。     

军字一号数据库索引的应用与维护探讨

军字一号医院信息系统是一个典型的数据库应用系统,其中使用了大量的索引对象,如何正确地使用和维护,关系到整个系统的性能.本文首先介绍了索引的作用及其优缺点,同时根据Oracle数据库的特点,提出了应用中建立索引应当掌握的原则,并针对应用中索引使用可能存在的问题,结合实际例句,阐述了如何合理使用索引,最后还根据军字一号的应用,简要介绍了索引的维护管理方案.     

浅析现代医院医疗设备管理信息系统建设

随着科学技术和信息技术的迅速发展,医疗设备管理的信息技术在医院管理中已广泛应用。医疗设备管理工作从原来的单纯设备购置与维修向设备质量管理和设备成本效益管理而转变,这对信息系统应用于医疗设备管理提出了更高的要求。通过对当前医院医疗设备管理信息系统应用的现状进行分析,介绍医院医疗设备管理信息系统功能定位要求和实施中的关键问题,避免医院的信息系统重复建设及少走弯路,使医院的医疗设备管理信息化建设迎来快速发展的新时期。     

数字化医院建设中的系统集成研究

在对医院HIS、RIS和PACS系统数据流和工作流分析之后,提出了1个医院信息系统建设中较有普遍意义的系统集成模型,通过1个典型的医疗信息系统设计,验证了该模型的有效性,设计出了基于HL7和DICOM标准的不同信息系统工作流集成方法.     

谈医院信息系统（HIS）建设

本文着重结合自己医院的HIS建设，总结了医院信息系统(HIS)建设中所面临的问题，并给出了解决方法。     

医保与医院信息管理系统接口方案的探讨

医疗保险信息管理系统是以城域网为主十的大型计算机管理系统，在我院已正常运转了两年。作为医疗保险定点医疗机构，医保系统与医院系统的接口问题必须得到解决。接口软件必须达到3个要求：医疗消费数据的唯一性、医保系统的安全性、高效快速的性能。医保系统与医院系统的接口采用3种方案：无缝、数据扫描、数据包交换。通过这3种方案，较好地解决了接口问题。     

Developing a clinical information system: an interpretive case analysis within a UK hospital.

This paper seeks to adopt an interpretive case analysis for the study of the development of a clinical information system within a UK hospital. An initial literature review is outlined, which draws attention to the distinction between formal-rational and interpretive perspectives on information technology impacts. A case study is presented where a number of issues are identified which suggest that formal systems analysis techniques do not reflect the organizational realities within the hospital. The paper concludes with a brief discussion of the concerns for systems development, and notes the value of an interpretive perspective in this respect.     

Problems regarding the integration of medical images into the total hospital information system

Since 1989, the integration of medical images into the total hospital information system (HIS) has been investigated and developed at Kochi Medical School. The basic concept of the integration is that, in the same way they can view text based data, doctors can retrieve and view images using the PC terminals of the total HIS. The possibility of utilizing the PC terminals of the total HIS as image viewing stations was investigated. A test run was performed in the period from October 1995 to July 1997. The test run revealed that fast image access is crucial in order for the system to be useful for doctors. After making various improvements, the final system became well used in the clinical practice. However, in order to progress to the film-less stage, the final system still has three problems that must be solved: quality of the image display, operation of multi-exams, and quality assurance of the digital image.     

西京医院器材科信息管理网络系统的开发及相关技术

本文研究了器材科管理的现状，结合最新的计算机发展技术，对网络过程中面临的数据共享问题、数据存储与存储的可扩展性等三大问题进行了较深入的研究，提出了可行的解决方案。     

医院内部医疗设备供货商资料的信息化管理

本文阐述了医院内部医疗设备供货商资料的信息化管理的必要性和可行性，并简单描述了管理环节的具体操作步骤。     

医院医学工程综合管理系统的开发与研究

目的:针对医院医学工程科设计一套综合管理信息系统.方法:基于asp.net(B/S)和SQLServer开发平台,以科学管理流程为标准,涵盖医院医学工程管理过程的各个方面.结果:该系统紧密结合相关法律法规,与军卫一号系统数据相融合,能够对全科室全面管理及监控,并且权限分级设置、责任明确、功能多样,使用方便.结论:计算机及网络技术的应用为医学工程科优化管理流程、整合信息系统及提供科学决策起到了至关重要的作用.     

医疗设备全程管理技术（十）—计算机数据库管理

本文提出了医疗设备引入计算机数据库管理的必要性，怎样开发一个管理系统，以及管理系统的主要内容。